![]() ![]() Recently, a study in a primary care clinic of 482 US children aged 4 to 7 years, reported a prevalence of 4.4%, with 95% having underlying constipation. Later studies in Sweden and the Netherlands revealed that, respectively, 9.8% and 4.1% of 5–6 year olds and 5.6% and 1.6% of 11–12 year olds suffered from fecal incontinence at least once per month. The reported prevalence among children 4 years of age was 2.8%, in those 7–8 years, it was 2.3% for boys and 1.3% for girls, and among 10–12-year-olds, 1.3% for boys and 0.3% for girls. Functional fecal incontinence in children is a common problem, reported in 1–4% of school-aged children. ![]() The exact prevalence of functional fecal incontinence associated with stool retention varies depending on the population studied. In the literature, fecal incontinence in children is frequently described by the terms “encopresis” and “fecal soiling”, but given the different meanings that these terms have across different cultures, Rome III and The Paris Consensus on Childhood Constipation Terminology (PACTT) have favored the term ‘functional fecal incontinence’, which will be used throughout this chapter.Įpidemiology of functional fecal incontinence in children The present chapter will focus only on functional fecal incontinence in relation to constipation. Fecal incontinence in children also occurs in a variety of organic diseases like congenital malformations, or neurogenic problems like myelomeningocele, and in other conditions affecting the anorectum, anal sphincters, or the spinal cord. Though this is the most common cause, it has recently been recognized that otherwise healthy children can also have fecal incontinence without any evidence of fecal retention, a group categorized as ‘functional non-retentive fecal incontinence’ (FNRFI). It has been suggested that in otherwise healthy children, fecal incontinence is secondary to ‘overflow’, and therefore results from the presence of constipation. ![]() In pediatrics, fecal incontinence has been defined as the voluntary or involuntary passage of feces into the underwear or in socially inappropriate places, in a child with a developmental age of at least 4 years. This review broadly addresses the epidemiology and pathophysiology of coexistent constipation and incontinence in both children and adults, and also reviews clinical presentation and treatment response in pediatrics.ĬOEXISTENCE OF CONSTIPATION AND INCONTINENCE IN CHILDRENĬonstipation in children is common, affecting between 0.7 and 29.6% of the general population worldwide, and is frequently associated with fecal incontinence. The treatment of underlying constipation usually results in improvement in incontinence. Incontinence has an important impact on quality of life and daily functioning, and in children may be associated with behavior problems. Pathophysiology of the incontinence is incompletely understood, although both in children and adults, it is thought to be secondary to overflow, while in adults it may also be related to pelvic floor dysfunction and denervation. ![]() In children, functional fecal incontinence is usually associated with constipation, stool retention and incomplete evacuation, and is frequently allied to urinary incontinence. The coexistence of constipation and fecal incontinence has long been recognized in pediatric and geriatric populations, but is grossly underappreciated in the rest of the adult population. ![]()
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